Organization
CITY OF MANISTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY CHARLES RUSSELL (DIRECTOR)
(906) 341-2134
Entity
Organization
Contact information
Practice address
300 N MAPLE ST, MANISTIQUE, MI 49854-1216
(906) 341-2134
(906) 341-0106
Mailing address
PO BOX 515, MANISTIQUE, MI 49854-0515
(906) 341-2134
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
771001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000078
—
MI
01
—
590G70001
BCBS PROVIDER ID#
MI
Enumeration date
05/27/2006
Last updated
03/08/2023
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